Patterns of Care and Outcomes of Elderly Esophageal Cancer Patients Not Meeting Age-based Criteria of the CROSS Trial

Vivek Verma, Waqar Haque, Dandan Zheng, Ferdinand Osayande, Chi Lin

Research output: Contribution to journalArticle

Abstract

Objectives: The CROSS trial established neoadjuvant chemoradiation followed by surgery (nCRT-S) as superior to surgery alone (S) for locally advanced esophageal cancer (EC). However, because patients above 75 years of age were excluded, this comparison cannot be extrapolated to older patients. This study of a large, contemporary national database evaluated practice patterns in elderly patients ineligible for CROSS, and analyzed overall survival (OS) between nCRT+S, S, and definitive CRT (dCRT). Materials and Methods: The National Cancer Data Base was queried for EC patients with cT1N1M0/T2-3N0-1M0 EC (per the CROSS trial) but 76 years and above of age. Multivariable logistic regression ascertained factors associated with nCRT+S (vs. S). Kaplan-Meier analysis evaluated OS; Cox multivariate analysis determined variables associated with OS. Propensity matching aimed to address group imbalances and indication biases. Results: Of 4099 total patients, 594 (14%) underwent nCRT+S, 494 (12%) underwent S, and 3011 (73%) underwent dCRT. Since 2010, trimodality management has risen, corresponding to declines in S and dCRT. Median OS in the respective groups were 26.7, 20.3, and 17.8 months (P<0.05). Following propensity matching, there was a trend towards higher OS with nCRT-S over S (P=0.077); dCRT showed poorer OS than nCRT-S (P<0.001) but was equivalent to S (P=0.669). Before and following matching, nCRT-S experienced equivalent 30- and 90-day mortality as S (P>0.05), with lower 30-day readmission and postoperative hospital stay (P<0.05). Conclusions: Although most older patients not meeting CROSS criteria undergo dCRT, utilization of trimodality therapy is rising. Despite the trend towards higher OS with trimodality therapy without poorer postoperative outcomes, careful patient selection continues to be essential in this population.

Original languageEnglish (US)
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
DOIs
StateAccepted/In press - Jan 1 2018

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Esophageal Neoplasms
Survival
Databases
Kaplan-Meier Estimate
Patient Selection
Length of Stay
Multivariate Analysis
Logistic Models
Therapeutics
Population
Neoplasms

Keywords

  • chemoradiotherapy
  • chemotherapy
  • CROSS trial
  • esophageal cancer
  • radiation therapy
  • surgery

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{98f8edf86a254361824200798c9f8b34,
title = "Patterns of Care and Outcomes of Elderly Esophageal Cancer Patients Not Meeting Age-based Criteria of the CROSS Trial",
abstract = "Objectives: The CROSS trial established neoadjuvant chemoradiation followed by surgery (nCRT-S) as superior to surgery alone (S) for locally advanced esophageal cancer (EC). However, because patients above 75 years of age were excluded, this comparison cannot be extrapolated to older patients. This study of a large, contemporary national database evaluated practice patterns in elderly patients ineligible for CROSS, and analyzed overall survival (OS) between nCRT+S, S, and definitive CRT (dCRT). Materials and Methods: The National Cancer Data Base was queried for EC patients with cT1N1M0/T2-3N0-1M0 EC (per the CROSS trial) but 76 years and above of age. Multivariable logistic regression ascertained factors associated with nCRT+S (vs. S). Kaplan-Meier analysis evaluated OS; Cox multivariate analysis determined variables associated with OS. Propensity matching aimed to address group imbalances and indication biases. Results: Of 4099 total patients, 594 (14{\%}) underwent nCRT+S, 494 (12{\%}) underwent S, and 3011 (73{\%}) underwent dCRT. Since 2010, trimodality management has risen, corresponding to declines in S and dCRT. Median OS in the respective groups were 26.7, 20.3, and 17.8 months (P<0.05). Following propensity matching, there was a trend towards higher OS with nCRT-S over S (P=0.077); dCRT showed poorer OS than nCRT-S (P<0.001) but was equivalent to S (P=0.669). Before and following matching, nCRT-S experienced equivalent 30- and 90-day mortality as S (P>0.05), with lower 30-day readmission and postoperative hospital stay (P<0.05). Conclusions: Although most older patients not meeting CROSS criteria undergo dCRT, utilization of trimodality therapy is rising. Despite the trend towards higher OS with trimodality therapy without poorer postoperative outcomes, careful patient selection continues to be essential in this population.",
keywords = "chemoradiotherapy, chemotherapy, CROSS trial, esophageal cancer, radiation therapy, surgery",
author = "Vivek Verma and Waqar Haque and Dandan Zheng and Ferdinand Osayande and Chi Lin",
year = "2018",
month = "1",
day = "1",
doi = "10.1097/COC.0000000000000481",
language = "English (US)",
journal = "American Journal of Clinical Oncology",
issn = "0277-3732",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Patterns of Care and Outcomes of Elderly Esophageal Cancer Patients Not Meeting Age-based Criteria of the CROSS Trial

AU - Verma, Vivek

AU - Haque, Waqar

AU - Zheng, Dandan

AU - Osayande, Ferdinand

AU - Lin, Chi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: The CROSS trial established neoadjuvant chemoradiation followed by surgery (nCRT-S) as superior to surgery alone (S) for locally advanced esophageal cancer (EC). However, because patients above 75 years of age were excluded, this comparison cannot be extrapolated to older patients. This study of a large, contemporary national database evaluated practice patterns in elderly patients ineligible for CROSS, and analyzed overall survival (OS) between nCRT+S, S, and definitive CRT (dCRT). Materials and Methods: The National Cancer Data Base was queried for EC patients with cT1N1M0/T2-3N0-1M0 EC (per the CROSS trial) but 76 years and above of age. Multivariable logistic regression ascertained factors associated with nCRT+S (vs. S). Kaplan-Meier analysis evaluated OS; Cox multivariate analysis determined variables associated with OS. Propensity matching aimed to address group imbalances and indication biases. Results: Of 4099 total patients, 594 (14%) underwent nCRT+S, 494 (12%) underwent S, and 3011 (73%) underwent dCRT. Since 2010, trimodality management has risen, corresponding to declines in S and dCRT. Median OS in the respective groups were 26.7, 20.3, and 17.8 months (P<0.05). Following propensity matching, there was a trend towards higher OS with nCRT-S over S (P=0.077); dCRT showed poorer OS than nCRT-S (P<0.001) but was equivalent to S (P=0.669). Before and following matching, nCRT-S experienced equivalent 30- and 90-day mortality as S (P>0.05), with lower 30-day readmission and postoperative hospital stay (P<0.05). Conclusions: Although most older patients not meeting CROSS criteria undergo dCRT, utilization of trimodality therapy is rising. Despite the trend towards higher OS with trimodality therapy without poorer postoperative outcomes, careful patient selection continues to be essential in this population.

AB - Objectives: The CROSS trial established neoadjuvant chemoradiation followed by surgery (nCRT-S) as superior to surgery alone (S) for locally advanced esophageal cancer (EC). However, because patients above 75 years of age were excluded, this comparison cannot be extrapolated to older patients. This study of a large, contemporary national database evaluated practice patterns in elderly patients ineligible for CROSS, and analyzed overall survival (OS) between nCRT+S, S, and definitive CRT (dCRT). Materials and Methods: The National Cancer Data Base was queried for EC patients with cT1N1M0/T2-3N0-1M0 EC (per the CROSS trial) but 76 years and above of age. Multivariable logistic regression ascertained factors associated with nCRT+S (vs. S). Kaplan-Meier analysis evaluated OS; Cox multivariate analysis determined variables associated with OS. Propensity matching aimed to address group imbalances and indication biases. Results: Of 4099 total patients, 594 (14%) underwent nCRT+S, 494 (12%) underwent S, and 3011 (73%) underwent dCRT. Since 2010, trimodality management has risen, corresponding to declines in S and dCRT. Median OS in the respective groups were 26.7, 20.3, and 17.8 months (P<0.05). Following propensity matching, there was a trend towards higher OS with nCRT-S over S (P=0.077); dCRT showed poorer OS than nCRT-S (P<0.001) but was equivalent to S (P=0.669). Before and following matching, nCRT-S experienced equivalent 30- and 90-day mortality as S (P>0.05), with lower 30-day readmission and postoperative hospital stay (P<0.05). Conclusions: Although most older patients not meeting CROSS criteria undergo dCRT, utilization of trimodality therapy is rising. Despite the trend towards higher OS with trimodality therapy without poorer postoperative outcomes, careful patient selection continues to be essential in this population.

KW - chemoradiotherapy

KW - chemotherapy

KW - CROSS trial

KW - esophageal cancer

KW - radiation therapy

KW - surgery

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